DESPERADO HOUNDS.PDF

Maricopa County
Animal Care And Control
2500 South 27th Avenue
Phoenix, AZ 85009
(602) 506-7387 Tele.
(602) 506-2739 Fax
KENNEL PERMIT APPLICATION
LI New ;s1 Renewal Permit #KIS— - Lj I 1 2
Name: -S-Ct e_KkL (P Kennel Name: 011920 r6ct) n
Mailing Address:,--C) 7 0 E. )('1I:e. cos E" F Kennel Location:
City C A- 1 A Z B ZIP S.:5aq 7 County Supervisorial District
Kennel Phone: t0a3 --totio--(6 - pl,bg Moi4R6Q. 1)6
Please complete and sign this application and return it to the above address with payment in the amount of three
hundred twenty eight dollars ($328.00) within ten (10) days of receipt.
Pursuant to Arizona statute and county ordinance, a person must obtain a kennel permit issued by the Board of
Supervisors if the person operates a kennel in which there are five or more dogs which are not individually
licensed. A.R.S. §11-1009(A). A kennel is defined as "an enclosed, controlled area, inaccessible to other
animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions." A.R.S.
§ 11-1001(8).
An appointment will be scheduled for inspection of the kennel premises by an Animal Control Officer upon
receipt of this kennel permit application and fee. This kennel application properly executed and a copy of the
inspection report will then be forwarded to, and must be approved by, the Maricopa County Board of
Supervisors. The kennel permit form will be sent to you after approval and will be valid for one year from the
date of the Board's approval.
NOTE: Failure to show for a scheduled inspection and/or failure of inspection will warrant a Subsequent
Inspection Return fee of $49 for each additional visit. Failure of inspection may result in denial of the kennel
permit and require individual licensing of each dog under the provisions of A.R.S. §11-1008.
PLEASE ANSWER THE FOLLOWING QUESTIONS AND INITIAL EACH RESPONSE
1. (.— I/We assume complete responsibility for the kennel at the premises for which i/we are making
app1fiation for a permit and understand that "kennel" means an enclosed, controlled area, inaccessible to other
animals, in which a person keeps, harbors or maintains five or more dogs under controlled conditions (ARS 11-
1001).
I/We certify that IANe have /3 dogs and that the kennel meets the definition in statute.
3. I/We certify that INVe have not been convicted of a violation of A.R.S. §§ 13-2910 (cruelty to animals)
Or 3-2910.01 (dog fighting), or similar violations of any other state, county or municipal animal welfare law.
(Violations of license and leash laws DO NOT apply).
4 INVe certify that all dogs over the age of three (3) months that are kept, harbored or maintained on the
pr ises of the above named kennel have been properly vaccinated against rabies by a veterinarian licensed to

practice in the state of Arizona and that a current vaccination certificate signed by a licensed veterinarian is
maintained on the premises for each dog.
5. 4._ I /We certify that INVe are submitting a valid copy of the rabies vaccination certificate for each
doh with this application.
INVe understand that a dog remaining within the kennel is not required to be licensed individually under
A.R.S. § 11-1008. l/we also understand that a dog leaving the controlled kennel conditions shall be licensed
under A.R.S, § 11-1008 except if the dog is only being transported to another kennel which has a permit issued
under this section.
7Q INVe understand that a person who fails to obtain a kennel permit under A.R.S.§11-1009 is subject to a
peiaity of twenty-five dollars in addition to the annual fee.
8. 1/We Ie understand that a person who knowingly fails to obtain a kennel permit within thirty days after
wriW tification from the county enforcement agent is guilty of a class 2 misdemeanor_
9. The undersigned understand that that the kennel permit , does not authorize the operation of'any type
of usiness and is solely used for the purpose of licensing multiple dogs.
InlVe certify that all of the information IA/Ve have provided is true and accurate under penalty of law.
Applicant Signature gatikAi ozet.Lektv_st Date: 4/-016-11
Applicant Signature Date:
For Official Use Only:
Copies of Valid Rabies Vaccination Certificates for each dog attached
Copy of Person's Valid Identification Attached
Type of Identification submitted
BOS Approval Date Term of Permit
2 of 2

Maricopa County
Animal Care & Control A/9 5-()a
2500 South 27'h Avenue
Phoenix, AZ 85009
Phone: (602) 506-7387
pets.maricopa.gov
KENNEL PERMIT PREMISE INSPECTION
APPLICANT Sa La i,-(3 re (9„e
STREET ADDRESS aO-7 0 E-_- 10)..c e
CITY, STATE, ZIP beci C-d-q
PHONE ALTERNATE PHONE
COUNTY DISTRICT r; KENNEL LICENSE #)LSI 0(3 NUMBER OF DOGS
1. Are all dogs over the age of three months properly vaccinated for rabies and in possession of a
valid rabies vaccination certificate?
Yes No
NOTE: Copies of each rabies vaccination certificate must be attached to the Kennel Permit
Premise Inspection form.
2. Is the kennel an nclosed, controlled area, inaccessible to other animals, in which a person
keeps, harbors 4r maintains five or more dogs under controlled conditions?
Yes No
CORRECTIVE ACTION NEEDED FOR COMPLIANCE AND DAYS GIVEN
BEFORE REINSPECTION. (Note: There will be $49 re-inspect fee payable to the Inspector by
check upon each return visit.)
Deputy Enforcement Agent Date

Maricopa County Animal Care and Control
2500 S. 27th Avenue
Phoenix, AZ 85009-6797
(602) 506-7387
htto://oets.maricopa.gov
Receipt Number: R14-167305 Receipt Date: 08125/2014
Person ID: P0999267
Phone: 480 2790993
DESPARADO HOUND KENNELS 8/25/2014 3:04:50PM
2070 E MELROSE ST
GILBERT, AZ 85296
Item: Animal ID: Reference No: Price: Each: Amount:
KEN PERMIT A7777777 K15-000013 $328.00 1 $328.00
Total Fees Due: $328.00
Payments: Cash: $0.00
Check: $328.00
Credit Card: $0.00
Total Payments Received: $328.00
Thank You!
Would you like to share your experience with our service to you? Change: $0.00
Please visit our website at http://pets.rnaricopa.gov and click on Balance Due: $0.00
"Contact Us" to email your comments for our review.
Animal Information:
A7777777 KENNEL PERM - BORN 9/1411999, SPAYED, UNKNOWN/MIX, TRICOLOR DOG
License Information:
Tag Number: License Expires: Animal# Vacc Date: Vacc Expires:
Please retain this receipt with your pet's records
APODACAP EBUSOFF

CaringHeart 'VACCINATION CERTIFICATE
Official Proof of Vaccination
Veterinary Services LLC cep this record in a safe place. Duplicate re quests $10. Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950 P.O. Box 7479 • Mesa, AZ 85216
PET OWNER: Fill ouf sections #1-6 OFFICIAL RECORD - PLEASE PRINT CLEARLY www.caringheartsvetservice.com
Last Name: lt: 'fI it Ai I I HEIM EL First Name: I in= PIED I I
Address: ()LI r ii 1L1 -ITTLHr n
City: FL d =PI= state: Zip: LILL
Email: A ( iv, Eltili; T ,/, im A DI= mi 11111111111
i
Home: %. Cell: ( ) - Ur). .7 _3 Work: (
I acknowledge having read and I understand the back of this document. Being aware
of these facts, I give my permission to CARING HEARTS VETERINARY SERVICES w , -,
LLC and/or the Doctor to treat and/or administer the vaccinations listed below. A. (_./ a DATE S / 1
0 New Client o Existing Client lilt Hiti rr111 rr1 11 1 II ff'1 11-$3 waste disposal fee per animal. Prescription ONLY fee $10.
How did you hear about this clinic? qfilyer from Store J Promotional Mailer fl Newspaper J Referral Ell TV 01 Radio n Website CI Drive By n Other
MEI PET #2
[-J Dog El Ferret 71 Mare S pa yThe u t Fp Pregnant n Dog Cf Ferret El Male Cl Spay/Neut 71 Pregnant
n Cat 0 Other fl Female n On Medication n Cat 0 Other Cl Female 0 On Medication
Name: Age: El Wks Name: Age: CI Wks
Breed: L CI Mos Breed: 171 Mos
Colors: — 1-7;)717 Yrs Colors: El Yrs
FOR OFFICE USE ONLY - PLEASE po NOT WRITE BELOW THIS LINE.
, Rabies Type: KILLED VIRUS Mfg. ' --) PRICE NEXT BOOSTERS Rabies Type: KILLED,VIRUS Mfg. n , 1 onicE NEXT BOOSTERS
`i .c1,-) ( . ) Tag # (Does riot include 3-4 6 12 36 Lot # ' „ Tag # - pnce (DOeS othoosters.) 00t i6Clude 3-4 0 12 36
._,---1 A.--rdov,, Price or boosters.) Weeks Months Months Months isuenu; ,.,1-ei. Weeks Months Months Months
Rabies Date Vaccinated: _ ‘,. / / I / / -C Rabies Date Vaccinated: / '
Rabies Vaccination Due: `::: i, J /6 ' Y., Rabies Vaccination Due: IJ $
DA2PPy / DA2PPv-11 / Corona $ IIMII-DA2PPv / DA2PPv+L/ CoMna I $
Bordetella - Nasal / Injectable $ • I Bordetella - Nasal / Injectable' $
L me / Rattle Snake $ Iyme / Rattle Snake $
Deworming jProtal 50 ms/m1 CC $ Dewarming (Protal 50 mi M ' cc $ ____
Cat 4-in-1 FVRCP / Leukemia $ Cat 4-in-I FVRCP /Leukemia $ _I ______, L_I- 1
Heartworm / 3DX / 4DX Test Et Pos O Nei $ Heartworm / 3DX / 4DX Test n Pos El Neg
FELV / FIV1Parvo I Giardia Test 0 Pos 0 Nei $ • FELV1 FIV/ Parvo I Glade Test El Poe Dile $ 1 I
Rx Heartworm MI': • I Rx Heartworm Mf•
Pets Wel. ht: CI 0-25# 0 26-50# 0 51-100# $ Pet's Weight: 0 0-25# El 26-50# 051-100#
Flea /Tick Control: $ I Flea / lick Control: $ \
Micro Chip Mfg. $ • Micro Chip Mfg. $
Micro Chip # • Micro Chi • #
Other: $ I Other: $ Fir_
Other: . $ NISI Other: $
Other: $ Qty: @ $ I Other: $ Qty: @ $
Other: $ Qty: • $ • Other: $ Qty: @ $
Treatment Fee: $ Serif t Fee. $10 I Tteatment Fee: $ Scri It Fee: $10 $
Exam Fee: $5 $20 Health Certificate: $25 $ . i ' . ._,. I Exam Fee: $5 $20 Health Certificate: $25 $ 1--- _j_i I _
Waste Dis•osal Fee: $1 •; $2 $3 $ I Waste Disposal Fee: $1 $2 $3 $
HR: ' Resp: ., NEXT BOOSTER DUE ON: HR : Resp : NEXT BOOSTER DUE ON: 1 I
Temp: ii .q . . Weight: , .- , - - NOTES! DOSAGE Temp: Weight: NOTES / DOSAGE
PHYSICAL EXAM: PHYSICAL EXAM:
Checked WW1° Check ClrecYei Unable to Check
Gen. App. 0 0 z 0 -,..- Gen. App. o o
Skin 0 0 o )3 cj "..;, Skin El 17
Eyes 11 El 0-1113_ s ocr —I A o ra °- a.io ,... '''' m a) Eyes 0 El
Ears El D 13t Ears 0 C
Mouth 11 0 sa,. P_ n 3:-. Mouth o 0
0 - 7)
HEALTH WITHIN NORMAL LIMITS in HEALTH WITHIN NORMAL LIMITS
Yes 0 No CI Yes El No (71
Veterinarian: Location: -1- 7 a 5 / • / ( J. Tech. init: Fee: $
State Lie # Date: Pd $ Bel $ Cash ID CVC Cashier !Pit: _ TOTAL: $_
White: CARING HEARTS VETERINARY SERVICES LLC Yellow: CLIENT! COUNTY

Owner RABIES VACCINATION CERTIFICATE
LINDA UGENTI
2310 NORCO DR.
NORCO, CA. 92860
n/la -Le/ eies
Phn: 19511736-3633 eterinarlan: Michael Auto
Tata ...sr. Cs en.:1 MY, 116 , 1).1
Animal Information
Name: PHEONIX Species: CAN Breed: BEAGLE Color: TRICOLOR Sex: M Age: 1Y9M
Vaccination Information
Date Vaccinated: 03/26/13 Type Vaccination: RABIES BOOSTER GOOD 3 YR Next Vaccination: 03/25/16
Vaccination Producer/Lot/Serial number: MERIAL IMRA83 RV12568
Owner RABIES VACCINATION CERTIFICATE
LINDA WENT!
2310 NORCO DR.
NORCO, CA. 92860
Ma-4.d dt7-166-/.44.t.,
Phn: 19511736-3633 veterinarian: Michael Butchko, DVM
ea
Animal information
Name: CASH Species: CAN Breed: BEAGLE Color: TRICOLOR Sex: M Age: 7Y8M
Vaccination Information
Date Vaccinated: 09/17/12 Typo Vaccination: RABIES BOOSTER GOOD 3 YR Next Vaccination: 09/17115
Vaccination Producer/Lot/Serial number: MERIAL IMRAB3 RVI 2558
CUT •CUT
Owner RABIES VACCINATION CERTIFICATE
LINDA UGENTI
2310 NORCO DR.
NORCO, CA. 92860
144eiditfAs . -AAA,
Phn: 19511736-3633 Veterlparlan: Michael Butchlut, uVM
Animal Information
Name: DIVA Species:CAN Breed: BEAGLE Color: WHITE Sex: F Age: 10Y1M
Vaccination information
Date Vaccinated: 09/17/12 Type Vaccination: RABIES BOOSTER GOOD 3 YR Next Vaccination: 09/ I 7/15
Vaccination Producer/Lot/Serial number: MENIAL IMRAB3 RVI2558
RABIES VACCINATION CERTIFICATE
Rob s Tag Number
MAW, Form S t
Owner's Name &Address PRINT- UM ballpoint pacer type
Lill First M.I. Telephone
U otk. L6--,0VA 92o) tiiiiC
No. S et City. , State Zip .
.E - k kv-os-6 bOlog---i- 552-'11
2010
SPECIES: SEX: AGE: SIZE: PtIOMINANT BREED: CO ORS:
Dog ..,,,Srn Male 1 mo.• 12 ,no. 0 Under 20 lbs. 0
Cat Ferrule El 12 mo. or older* 20 - SO lbs.
Other 0 Neutered 0 "21 0+er lb. E-1, NAME!
Please specify fiX"/ r
DATE VACCINATED: VETERINARIAN: ",...)
chtilL 0 l'' I e' l'.
PRODUCER! .-..- a3r7
Veterina 3 It
Month Day ' ear Ucenm No
Firs 31 to n
VACCINATION EXPIRES: I yetis. /Vacdne 0 st.ICENNEVCARE-
3 „.. u, Iv.„ 1,,e Vote nan's
ei 0 k la— VETERINARY HOSPITAL
Month Day ' Year (.31 °Li 11 0 Add.
6277 W. Chandler Blvd.
Vaccine Serial ILO No.
Chandler. AT 85,926

oularn, rUlAll J- 1
Owner's Name &Address PRINT - use ballpoint pen or type
Las
(be,
No. State Zip -
`7` A7j ;C)
r2b
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COL7RS:
Dog Male 0 3 mo.- 12 mo. 0 Under 20 lbs.
Cat 1:1 Female 12 mo. or oldeD 20 - 50 lbs
Other LI Neutered 0 Over 50 lbs.
Please specify
DATE VACCINATED:
CYS PRODUCER:
Month Day
(First 3 letters
VACCINATION EXPIRES: 1 yr. Lit. /Vaccine'
06- 3 yr. Lit. /Vaccine 0 Veterinadan's &km
VETERINARY HOSPITAL
Month D -Year i4 -)4)1_73 Address: 6277 W. Chandler Blvd.
Vaccine Serial (Lot) No.
.z4, 4141,
RABIES VACCINATION CERTIFICATE Rabies Tag Number
NASPHV Form 51
Owner's Name &Address PRINT - use ballpoint pen or type
Last L. First M.I.
Ct kij fine A.--1 si 12\ -C.,-V;k4
Np Street City State Zip
/1.
SPECIES: SEX: AGE: SIZE:
Dog Male rno.- 12 rno. 0 Under 20 lbs
Cat 0 Female RI 12 mo. or older 0 20-0 lbs. El
Ocher 0 Neutered 0 j smh Over 50 lbs. 0
Please specify
DATE VACCINATED:
0 PRODUCER:
Month Day Year
(First 3 letters
VACCINATION EXPIRES: I yr. Lie./ Vaccine
3 yr. Lit. /Vaccine 0 Veterinariap Si gnat
0 LI `1-D VETERINARY HOSPITAL
Month Day Year -r1"/PL11 -/ Address: 6277 W. Chandler Blvd.
Vaccin Serial (Los) No. Cbnnrilpr, AZ 8,529,6
RABIES VACCINATION CERTIFICATE
Rabies Tag Number
NASPHV Form Si
Owner's Name & Address PRINT - use ballpoint pen or type
Last 1 First , M.L. ; ,Telenhone
LAken-I CA-.) Joe,v,e
, ,,?0 Str et ---.-- , City State Zip
SPECIESVSEX: 7AGE: SIZE: PREDOMINANT REED: COLORS:
Dog Male Bili ll 3 mo.- 12 ... 0 Under 20 lbs. 0 11 çD-
Cat 0 Female 0 12 mtt or older 0 20 - 50 lbs.r.V13 tal-3/6-----" 1
Other 0 Neutered El ( -T) -(1 t-i Over 50 lbs. 0 NAME:
Please specify
DATE VACCINATED: VETERINARIAN:
(8 OS 1 Li PRODUCER: j- ...1.-.
Veterin 1 . /
Month Day ' Year License No.
First 3 letters
VACCINATION EXPIRES: I yr. LiciVaccinB/ - ' gnatUNNEL CARE
' 3 yr. Lic./Vaccine Si 0 Veterinaria
OS." 0 V TERINARY HOSPITAL
-3/' Li ---; iLert) i -3
Month Day ' Year Address: 6277 W. Chandler Blvd.
Vacc e Serial (Lot) a.
rhandlpr AZ 85726

ABMS VACCINATION CERTIFICATE RabiesTag Number
NASPHV Form 51
Owner's Name &Address PRINT - use ballpoint pen or type
First Ml. Telephone
Last
L —Sat \if—% 1 ‘& \
No. Street City State Zip
aem E .17u7-,e, Pkt
SPECIES: SEX: AGE: SIZE: PREDOMINANT BREED: COLORS:
Dog ;A we 131 3 rno.- 12 mo. Under 20 lbs.
Cat 0 Female 0 12 mo. or raider VI 20 - 50 lbs. W. becv(pQ.,
Other 0 Neutered 0 Over 50 lbs. D NAME:
Please specify
\\C.)
DATE VACCINATED:
(.76 el;
\
Month Day Year (first 3 Setters
VACCINATION EXPIRES: 1 yr.Lic. /Vaccine D
3 yr. Lit/Vaccine
,
Month Day Year
RABIES VACCINATION CERTIFICATE
I Rabies Tag Number
NASPHV Form 5
Owner's Name &Address PRINT - use ballpoint pen or type
Last First M Te 11.nhp
L41,0{2 ' -_)PC\6k 771 NA
No. Street State
PI 1 Gi 1-.),(A.+- AZ—
SPECIES: AGE: SIZE: IVIIII30MINANT BREED: COLORS:
Dog Male 3 mo.- 12 mo. D Under 20 lbs. IH11
Cat 0 Female 12 mo. or 01.:17. 20 - 50 lb s. 1 Pc..11 11—
Other 0 Neutered-0 Over 50 lbs.""MI ArssIE-, e,;(-1k CArq.
Please specify
DATE VACCINATED: VETERINARIAN:
i 3 PRODUCER: r
Veterinarian's
Month Day Year
First 3 letters
VACCINATION EXPIRES: I yr.Lic./Vaccine D
3 yr. Lic./Vaccine
sS t 1 ERINARY HOSPITAL
Month Day Year A Address:
6277 W. Chandler Blvd.
Vaccine Serial (Lot) No.

[fri VACCINATION CERTIFICATE
- 0255 1
Official Proof of Vaccination
Veterinary Services L1C Keep this record in a safe place. Duplicate requests $10. Corporate Office Hours:
Mon - Fri 9:00 am - 5:00 pm
480-699-9950 P.O. Box 7479 • Mesa, AZ 85216
PET OWNER: Fill out sections #1-3 OFFICIAL RECORD - PLEASE PRINT CLEARLY www.caringheartsvetservice.com
Last Name: A.111 (_ .-- First Name: M I I I
Address: 1111. •-idr-7.77 DOM MI I LILEEPTI IED I I l
E DEr [ I I I IM I State: Zip: REIEI
bio R V i 6117 ;_,LliLL EIMEI 111M
11-11:orrnuI Cell: ( ) 14yo - iS-75 Work: (
dge having read and I understand the back of this document. Being aware
I give my permission to CARING HEARTS VETERINARY SERVICES
the Doctor to treat and/or administer the vaccinations listed below. , 0.. DATE / I! /
nt ID Existing Client Did you get a reminder card in the mail? O Yes J Ni There is a $1-$3 waste disposal fee per animal. Prescription ONLY fee $10.
How did you hear about this clinic? Flyer from Store DI Promotional Mailer ID Newspaper n Referral El TV DI Radio 1J Website n Drive By El Other
PET #2
71 Dog 173 Ferret p Male Cppay/Neut El Pregnant fl Dog El Ferret n Male El Spay/Neut El Pregnant
Fl Cat CI Other Female 17 On Medication El Cat n Other El Female n On Medication
Name: Age: El Wks Name: Age: El Wks
Breed: L.( El Mos Breed: El mos
Colors: El Yrs Colors: CI Yrs
FOR OFFICE USE ONLY - PLEASE DO NOT WRITE BE OW THIS LINE
Rabies Type: KILLED VIRUS Mfg. p 1 - PRICE NEXT BOOSTERS : Rabies Type: KILLED VIRUS Mfg. !,,i /7 _,.= PRICE NEXT BOOSTERS
Lot # ' . . .., • t ..-1 t7 E Tao (Does not Include 3-4 6 12 36 Lot # r ) - ,---. 1 `-, ,.... 4,-) j (--) , Tag # ' (Does not include 3.4 jr. 12 36
Rabies Date Vaccinated: (-7, 1 1 i i (ee.epdsac.g,e0.. i / -;, Plice of boosters.) Weeks Monlhs Months Month , / i . ele-.1.e.tre.11,fteo Vie° or !masters.) Weeks DIM Months Months
I r Rabies Dale Vaccinated: .`') / / / / / -'
Rabies Vaccination Due: • / / i / (.-, $ t .2., 2 r 1 ''' - I ', Rabies Vaccination Due: /LZ/.11-L_
DA2PPv / DA2PPv-EL / Corona $ -DA2PPv / DA2PPy+L / Corona _ , !$ $
Bordetella - Nasal / Injectable $ Bordetella - Nasal / Injectable $
L me I Rattle Snake $ L me / Rattle Snake $
Deworming (Protal 50 mg/m1) cc $ ---- II Deworming (Protal 50 mq/mI) cc $
Cat Cat 4-in-1 (FVRCP)/ Leukemia $ A Cat 4-in-1 (FVRCP} / Leukemla — -
Heartworm / 3DX / 4DX Test 0 Pos CI Neg $ Heartworm / 3DX / 40X Test 0 Pos CI Nes
FELVIFIV/ Parvo / Giardia Test 0 Pos 0 Neg $ FELV /FIV / Parvo / Giardia Test 0 Poe CI Nal $
Rx Heartworm Mfg: Rx Heartworm Mfg:
Pet's Weight: CI 0-25# 0 26-50# 0 51-100# $ . . Pets Weight: 0 0-25# 17126-50# 0 51-100# $
Flea/Tick Control: $ I Flea/Tick Control: $
Micro Chip M. $ Micro Chip Mfg. $
Micro Chi. # _ Micro Chip #
._.
Other: $ IIII Other: $
Other: $ Other: S
Other: $ Qty: @ $ Other: $ Qty: @ $
Other: $ Qt . @$ Other: _ _ I $ Q: $
Treatment Fee: $ Script Fee: $10_ $ Treatment Fee: $ Seri t Fee: $10 $ -
Exam Fee: $5}$20 Health Certificate: $25 $ '<= 0 '.4. Exam Fee: $5120 Health Certificate: $25 $ rc.t._.)
— Waste Dis • osal Fee: '.1 .) '.2 '.3 V $ i b v Waste Dis osal Fee: $1 $2 3 0$ .
HR: \ \ - ) Res kr) , NEXT BOOSTER DUE ON: "-- ss, // J ' 6, . HR. . ' 1 , ,, '‘) —, Resp: L1'.' ) NEXT BOOSTER DUE ON: Lc . J
Temp: ?/.'1(') • -1 Weight: /13`_/ NOTES / DOSAGE ,,, .... (T. , ,;, Temp: 1 I t. .1, I ) , Weight;- - .-- ./ -0. i. ,i c • .i.' , .
NOTES / DOSAGE
PHYSICAL EXAM: PHYSICAL EXAM:
Checked Unubto to Check Checked
Gen. App. 171 0 i . .: , , Gen. App. c um"Ochec'
Skin - 171 0 Skin 0 El
Eyes 17 0 .vV.) Y.; Y:V - Eyes 0 0
Ears b o 0 z 0 - r_ > • . - Ears 0 0
Mouth m i 0 m 73 II --1 K 8 (-),‹ 9.; E. ..' Mouth 0 CI
HEALTH WITHIN NORMAL LIMITS . 2 F-3 A II o (b HEALTH WITHIN NORMAL LIMITS
Yes 171 No D . szt..6--) z 0-- r....) % '--, 0, -1,>• co Yes El No 0
Veterinarian: - Location: 23 , Tech. Init: Fee: $
State Lie # Date: 51 Pd $ Bal $ Cash in CC o ../cyc -- Cashier !nit: ' TOTAL: $.' •
' White: CARING HEARTS VETERINARY SERVICES LLG Yellow: CLIENT / COUNTY

CaringHeart VACCINATION CERTIFICATE r 9
Official Proof of Vaccination kJ
Veterinary Services. Keep this record in a safe place. Duplicate requests SlO. Corporate Office Hours:
Mon - Fri 900 am - 5:00 pm
480-699-9950 PO. Box 7479 • Mesa, AZ 85216
OFFICIAL RECORD - PLEASE PRINT CLEARLY www.caringheartsve/serviceiciorn
Last Name: 11111111611111111111111111111111•MIN First Name: E E E
Address: U ' I .1 _1 11111EILI•E E •E• •ll•••EEE JUIT I I 17
City; IIFT I n la_LITI 1 n ZipljThrfl
Email H I
Horses: , Work:
I acknowledge having read and / understand the back at this document. Being aware
of these facts, I give my permission lo CARING HEARTS VETERINARY SERVICES v
LLC and/or the Doctor to Veal and/or administer the vaccinations listed below. ' DATE ,
• New Client Er En/sting Client Old you gel a reminder card In the mai? 71 Yes ONG There Is a $1-53 waste disposal lee per animal. Prescription ONLY fee 510.
How did you hear about this clinic? Flyer kern Store (7I Promotional Mailer 171 Newspaper El Referral []TV Radio i1 Website J Once By El Other
D. Dog n Ferret Male Olt 09/Nu4- Pregnant Cl Dag Ferret 1 Male 7 Spay/hleut Cl Pregnant
n Cal Ti Other 1 Female 1 On Medication fl Cat Other Ti Female Ti On Medication
Nome - _ Age: 10 wks Age: -1 Wks :
Breed , '0 Mon Breed '\ ktos
Colors Cl Yr; Colors: +1 Vs !
FOR OFFICE USE ONLY - PLEASE DO --,--- NOT WRITE BELOW THIS LINE
Rabies Typo: KILTED VIRUS pry . PRICE NEWF BOOSTERS iiabRsTym KILLED VIRUS :.v,1 PRICE NEXT nBig OOS TER S
Lot # _ „/ _,_-, ' t - / • /. 17 Tag " 4 _ , , It K L o0 \ Tag# :-• • .....i 1,74k , 7. ., _
:,.._ m \
Rakes Date Vaccinated: 1-- I / I .., R bes Date Vaccinated: r
Rabies Vaccination Due: :• P I 1 _f_____._ 5 • ' Rabies Vaccrnabori Duo - .., / ._
DA2PPv / DA2PPv+L /Corona . s DA2PPv / DA2PPv 41 / ona S MI
I3ordetelia - Nasal / Injectable 5 Bartietera - Nasal i injectable $
Lyme I Rattle Snake 5 Lyme I Rattle Snake 5 .
Deworming (Protal 50 moinili cc s Deworminq (Prole 50 rrielml) cc S
Cat 4-in-1 (FVRCP) / Leukemia A , Cat 4-in-1 (FVRCP1/ Leukemia 5
Heartworrn i 3DX / 4DX Test 0 Pus 71 trag $ Hearhvorm i 3DX / 4DX Test . Ti Pis ;-1 Neu S
FELV i MI Parvo/Giardia Test Cl Pas 7 Nag i $ ray) FIV i Parvo/Giardia Test 0 Pen ..71 Nog S I
Rx Hearhvorrn Mfg: Rx Heartworm Mfg:
Pers Weight: 0 0-254 Ti 26-504 7151-100# S ' IMF Pet's Weight: El 0-2511 0 26-5041 -7151-1604 $ rill
Flea I Tick Control: s Flea! Tick Control: , s
7 7
Micro Chip Mfg , 5 Micro Chip killg. 5
Micro Chip ft -. -. Micro Chip 4
Other: $ Other
Other: $ Other: $
Other: 5 Qty; @ 5 Other: i, Oly: @ $
Other: 5 Qty: fii $ Other: \, Obi: 0 $ .
Treatment Fee: $ _ Script Fee: 510 5 Treatment Feet $ Script Fee: $10 5 ' \
Exam Fee . 55'520 Hearth Certificate! $25 5 •-..,4,-' , Exam Fee: $5 520 Health Certificate: $25 5 ',... Tr
Waste Disposal Fee: 51 t $2 $3 — Waste Disposal Fee: 51 52 53 $
let: ' Resp - NEXT BOGSTER DUE ON. ir Hit Resp: NEXT BOOSTER ME ON: —11 11-1
Temp • _ ._ Weight. ____-_,_ NOTES /DOSAGE Temp: Waigni NOTES t DOSAG
PHYSICAL EXAM: , __.1. ,t 1 . „,, -r TI PHYSICAL EXAM: \
ENtri k.t. bC-A, thda lsiti*Al. .. __.
GenApp. . E 0 4., Gen. APP. n 0 \
Skin E1 EJ 5 c 9? t -------- Skin 0 0 - ----.
Eyes 0 -- . 5 -01 (r- v E Eyes 0 0
Ears n ^M----4-1=---(12-E-- Ears 0 71
Mouth M 113 M : 3 a Mouth 0 El
HEALTH Willilit NORFANL LIMITS ___ 2 HEALTH WITHIN NORMAL LIMITS
Yes 0 Na ri Yes 0 No /71
Veterinarian: Location: Tech, Fee: $
State Lic if Date: Pd $ Bal $ Cash. 0 CC CVC Ceshrec loft: TOTAL: $
WhIer CARING HEARTS VETUll NANY SERVICES 1LC Ye! ow- CUENT1 COUNTY